European Radiology

, Volume 29, Issue 2, pp 663–673 | Cite as

Intracardiac cement embolism during percutaneous vertebroplasty: incidence, risk factors and clinical management

  • Sarah Fadili Hassani
  • Evelyne Cormier
  • Eimad Shotar
  • Mehdi Drir
  • Jean-Philippe Spano
  • Laetitia Morardet
  • Jean-Philippe Collet
  • Jacques Chiras
  • Frédéric ClarençonEmail author



To evaluate the incidence and risk factors for ICE during a PV.

Materials and methods

Single-center retrospective analysis of 1512 consecutive patients who underwent 1854 PV procedures for osteoporotic (34 %), malignant (39.9 %) or other cause (26.1 %) of vertebral compression fractures (VCFs)/spine tumor lesions. Only thoracic or lumbar PVs were included. PVs were performed with polymethylmethacrylate (PMMA) low-viscosity bone cement under fluoroscopic guidance. Chest imaging (X-ray or CT) was performed the same day after PV in patients with high clinical suspicion of ICE. All post-procedural chest-imaging examinations were reviewed, and all ICEs were agreed upon in consensus by two radiologists.


ICEs were detected in 72 patients (92 cement embolisms). In 86.1 % of the cases, concomitant pulmonary artery cement leakage was detected. Symptomatic ICEs were observed in six cases (8.3% of all ICEs; 0.32% of all PV procedures). No ICE led to death or permanent sequelae. Multiple levels treated during the same PV session were associated with a higher ICE rate [OR: 3.59, 95% CI: (1.98-6.51); p < 0.001]; the use of flat panel technology with a lower ICE occurrence [OR: 0.51, 95% CI: (0.32-0.83); p = 0.007].


Intracardiac cement embolism after PV has a low incidence (3.9 % in our study). Symptomatic complications related to ICE are rare (0.3%); none was responsible for clinical sequelae in our series.

Key Points

• The incidence of intracardiac cement embolism (ICE) during PVP is low (3.9%).

Having a high number of treated vertebrae during the same session is a significant risk factor for ICE.

Symptomatic intracardiac cement embolisms have a low incidence (8.3% of patients with ICE).


Percutaneous vertebroplasty Leakage Cement Embolism Cardiac Complication 





Intracardiac cement embolism




Pulmonary cement embolism




Percutaneous vertebroplasty


Right atrium


Right atrial appendage


Right ventricle


Vertebral compression fracture



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Frédéric Clarençon.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was not required because French law states that no approval from a local IRB is necessary for retrospective analysis of patients' charts.


• retrospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Sarah Fadili Hassani
    • 1
  • Evelyne Cormier
    • 1
  • Eimad Shotar
    • 1
    • 2
  • Mehdi Drir
    • 3
  • Jean-Philippe Spano
    • 2
    • 4
  • Laetitia Morardet
    • 5
  • Jean-Philippe Collet
    • 6
  • Jacques Chiras
    • 1
    • 2
  • Frédéric Clarençon
    • 1
    • 2
    Email author
  1. 1.Department of NeuroradiologyPitié-Salpêtrière Hospital, APHPParisFrance
  2. 2.Paris VI UniversityPierre et Marie CurieParisFrance
  3. 3.Department of AnesthesiologyPitié-Salpêtrière HospitalParisFrance
  4. 4.Department of OncolyPitié-Salpêtrière HospitalParisFrance
  5. 5.Department of RheumatologyPitié-Salpêtrière HospitalParisFrance
  6. 6.Department of CardiologyPitié-Salpêtrière HospitalParisFrance

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